Transjugular intrahepatic portosystemic shunt with expanded-polytetrafuoroethylene-covered stents in non-cirrhotic patients with portal cavernoma

Patient 9: Evidence of luminal stenosis at the level of the non-covered portion of the stent, successfully treated with angioplasty and re-stenting.

Patient 11: Successful TIPS placement in a 30-year old woman with essential thrombocythaemia and portal cavernoma. (A) Guidewire advancing from the left portal branch through the main portal vein. (B) Portal venogram performed after the portal vein occlusion was crossed, showing a patent superior mesenteric vein (SMV) and the occluded main portal vein with cavernous transformation. (C) Venogram performed after TIPS placement with recanalisation of the portal system.

Patient 12: Attempt for TIPS creation in a 41-year old man with idiopathic myelofibrosis and portal cavernoma. (A) Venogram after crossing the thrombosed remnant portal vein showing the lack of visualisation of a valid communication with the other splanchnic veins. (B) The only visualised venous tract was a small coronary vein feeding the oesophageal varices, probably not sufficient to keep the stent open.

Patient 7: Successful TIPS placement in a 37–year old man with portal cavernoma since childhood. (A) CT scan showing the occlusion of the portal vein at the hilum with large pericholecystic collateral veins supplying the intrahepatic portal veins. Extensive venous calcification and presence of a spontaneous spleno-renal shunt. (B) Venogram showing an occluded superior mesenteric vein. (C) Venogram performed after portal vein reconstruction and TIPS placement with the distal end of the stent into the patent splenic vein.